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Electronic health records: managerial insights from an umbrella review

Belle N, Gazzetti A, Cantarelli P, Cruciani V, Gandolfi S, Piazzoli A

BMC health services research, 2026

Abstract

Background: Healthcare systems are increasingly implementing tools that aid the decision-making process of professionals. There is a clear need to develop evidence-based managerial guidelines for implementing electronic health records. This umbrella review aims to identify a parsimonious yet comprehensive set of factors that enhance the efficiency and effectiveness of electronic health records in supporting professionals' decision-making.

Methods: We analysed 199 literature reviews and meta-analyses to classify key factors influencing electronic health records' performance into technological, human, and institutional domains. For each domain, we systematized implications and recommendations relevant to healthcare management.

Results: Technological factors account for the largest share of existing research, with data management, artificial intelligence, and usability emerging as the most frequently studied areas, while barriers related to ICT infrastructure and software receive comparatively less attention. Human factors are also widely examined, particularly user familiarity, nudges, and system use, whereas collaboration, ethics, and enforced actions are less frequently addressed. Institutional factors primarily concern adoption processes and acceptance, followed by access and workflow optimization; privacy and guidelines are discussed to a lesser extent, while customization and evaluation remain relatively underexplored.

Conclusions: Healthcare managers should prioritize…

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